Provider Demographics
NPI:1801376629
Name:BAKER, SHELLETTA
Entity Type:Individual
Prefix:DR
First Name:SHELLETTA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 N LAURA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:904-321-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No251300000XAgenciesLocal Education Agency (LEA)
No253Z00000XAgenciesIn Home Supportive Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374J00000XNursing Service Related ProvidersDoula
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376J00000XNursing Service Related ProvidersHomemaker